A Discussion on Palliative Care

Danielle B. Scheurer, MD, MSCRChief Quality Officer & Hospitalist

April 12, 2012 – MUSC BOT Retreat

Background• 5% of seriously ill Americans account for 50% of health

care spending, primarily in the last year of life.• Majority of patients-families report end of life unmet

needs (pain, discomfort, emotional / spiritual distress, caregiver burdens).

• Discordance between previous wishes and actual care.• Only 30% of elderly patients hospitalized at the end of

life have documentation of their wishes in the medical record.http://content.healthaffairs.org/content/32/3/552.full.html

Heyland DK. JAMA Intern Med. Published online April 01, 2013. doi:10.1001/jamainternmed.2013.180

Background

Hospice enrollment and Medicare savings

• Time of hospice enrollment and savings per beneficiary (compared to non-hospice)

• 1-7 days before death: $2,500• 8-14 days before death: $5,000• 15-30 days before death: $6,500

http://content.healthaffairs.org/content/32/3/552.full.html

Average Medicare Inpatient Spending in the Last 6 Months of Life

Average Medicare Outpatient Spending in the Last 6 Months of Life

http://www.capc.org/reportcard/home/SC/RC/South%20Carolina

http://www.capc.org/reportcard/home/SC/RC/South%20Carolina

Current MUSC Palliative Care Resources

• Inpatient Clinical Service– 1.5 FTE physician, 1.0 FTE APP– Available SW, case mgt, chaplain, ethics (not

dedicated to palliative care)• Interdisciplinary reviews• Screening with mandatory action (pilot)• Physician Order for Scope of Treatment (pilot)• Education Med Students, Residents, Nurses

Future MUSC Palliative Care Resources

• Palliative care fellowship– 2 fellows annually– Proposal circulating

• Clinic / Outpatient Service– Half day weekly on site

• Research– Recruiting

Challenges

• Culture change– Patients-Families– Physicians-Staff

• Community & State involvement– CAPC rates SC a “C” overall– Larger and non-for profit hospitals more likely

to offer services– Non-hospital services patchy

Discussion Points

• Spending is very high at the end of life.• Many patients-families do not receive care

concordant with wishes at end of life.• Early palliative care involvement is best.• MUSC should be a mentor in the state on

the creation and sustainment of in-outpatient palliative care services.